WHOOP Podcast - Changing the Conversation Around Menopause with Dr. Jessica Shepherd

Episode Date: March 1, 2023

On this week’s episode, WHOOP VP of Performance Science Kristen Holmes is joined by OB/GYN and women’s health expert Dr. Jessica Shepherd. She is the Chief Medical Officer for Verywell Health. She is the founder and CEO of Sanctum Med + Wellness, a wellness concierge practice. Dr. Shepherd is also a member of the WHOOP Scientific Advisory Council and is also the founder of Her Viewpoint, an online women's health forum that focuses on addressing taboo topics in a comfortable setting. Kristen and Dr. Shepherd discuss why men should learn about menopause (5:55), what is happening in the body during menopause (8:10), the timing of entering menopause (11:15), the hallmark symptoms of menopause (13:15), advice on getting good sleep when experiencing symptoms (17:00), hormone replacement therapy (22:25), how to detect whether you’re in perimenopause (28:05), nutritional tips and behavioral recommendations (33:15), understanding mindsets and habits (40:40), health risks associated with postmenopause (46:55), Don Lemon on women in their primes (54:25), and the women’s health space over the next 10 years (58:25).Resources:Verywell Health Dr. Shepherd on InstagramSanctum Med + Wellness on InstagramNY Times Article: Women Have Been Misled About MenopauseSupport the showFollow WHOOP: www.whoop.com Trial WHOOP for Free Instagram TikTok YouTube X Facebook LinkedIn Follow Will Ahmed: Instagram X LinkedIn Follow Kristen Holmes: Instagram LinkedIn Follow Emily Capodilupo: LinkedIn

What's up, folks? Welcome back to the WOOP podcast. We're on a mission to unlock human performance. I'm your host, Will Ahmed, founder and CEO of Woop. Okay, we're kicking off Women's History Month here in March, and we wanted to bring on a guest who can shed some light on, you guessed it, women's health. Our VP of Performance Science, Kristen Holmes, is joined by OBGYN, and women's health expert Dr. Jessica Shepard.

Dr. Shepard is the chief medical officer for very well health. She's the founder and CEO of Sanctum Med and Wellness, which is a wellness concierge practice. Dr. Shepard is also a member of the WOOP Scientific Advisory Council, so we appreciate all the advice that she gives us guiding the company and its products. Dr. Shepard is also the founder of her viewpoint, an online women's health forum that focuses on addressing taboo topics in a comfortable setting. Kristen and Jessica discuss what is happening to the body during menopause.

This includes the shifting hormone levels such as estrogen and progesterone. How to determine whether you are in paramenopause or menopause? There's symptoms, for example, hot flashes, weight gain, mood swings that they get into, creating the right hormone therapy profile for you, how to deal with the health risks associated with menopause, this can include heart disease, osteoporosis, colon cancer, so it's serious, tips on how to have a balanced nutrition and good night sleep while experiencing menopausal symptoms.

Turns out the quality of the food really matters. I found that quite interesting. And Dr. Shepard's outlook on the next 10 years of menopausal research and women's health. If you're new to Whoop, you can use the code Will when you're checking out, get a $60 credit on Woop Accessories. That's at Woop.com. You can also email us, podcast at Woop.com, or call us 508443-4952, and your questions might be answered on a future episode. Without further ado, here are Kristen and Dr. Jessica Shepard. Dr. Shepard is a renowned OBGYN and women's health expert.

She is the chief medical officer for Very Well Health, the founder and CEO of Sanctum Med and Wellness and is affiliated with Baylor University Medical Center in Dallas, Texas. In her Dallas practice, she works with a team of therapists, yoga instructors, Ayurvedic wellness coaches, nutritionists, exercise specialists, and other health professionals dedicated to women's health. Along with writing for numerous health journals like Women's Health, Dr. Shepard is seen regularly as an expert on the Today Show, Dr. Oz, Steve Harvey, CBS News, and WCIU in Chicago, where she is a monthly health contributor as well as guest co-host. And we are so, so grateful to have Dr. Shepard as a member of the WOOP Science Advisory Council. Dr. Shepard, welcome to the

Woo Podcast. Thank you so much for having me. And I'm so excited, one, to be here, but even more so proud to be part of the Scientific Advisory Board, because this is something that is like near and dear to my heart. So excited to be here. Yeah. I mean, when we had a chance to meet, gosh, at the Hologix, that was, gosh, that was November, right, of 2022. That was, no, remember that was U.S. Open Time. Oh, gosh. So that was, yeah. it was even earlier. Well, I knew at that moment, I was like, oh, my gosh, we need to get Dr. Shefford involved in our mission. It was just so much alignment. And I was just astounded by just your level of expertise and just how, you know, you just have this real natural

curiosity about you. And you're just, you know, it's not just, you know, clocking in and clocking out. I mean, you have this deep, deep passion for women's health. And you want to just get to the bottom of it all is like this passion. And, you know, what I am fascinated, by is, yes, I spent so many years in medical school and learning, you know, surgical techniques and, but it's really the patients that drive the curiosity, I would say. So, you know, seeing patients, you know, in clinical practice for 15 years, what I realize is that there's so many underlying questions that have, that resonate from this same level of, it's like a kind of like a ceiling. Like women know so much, but then above that, there's more that they need.

to know, but they're not quite sure how to access that information. And I can honestly say that a lot of the times I didn't necessarily have the answers, which means that we needed to do a better job with probing these questions and then also advancing literature and science into how is this impacting women, especially when we're thinking of women who are in their mid-40s through 50s. Yeah. Yeah, I would imagine it's hard to see women come in, you know, in pain, you know, mentally and physically and not really know what to do about it, you know. And I think that's where hopefully our collaboration around just the research and looking into some of this physiological data, we're able to see some signals, you know. And again, I think it's, it's,

we're kind of going, I want to be able to understand, you know, how to apply our effort in these, during these different inflection points and hopefully, you know, mitigate some of the deleterious effects of metapause and perimenopause, you know, which is going to be the topic of conversation today. Dr. Shepard, before we kind of dig into perimenopause and menopause, why should guys listen to this podcast? I think it's obvious why women might be interested in this podcast, but why do you think the men in women's lives should have a listen to this?

Yeah, I think that that is probably the most important thing to feature prior to digging into this topic because obviously women are going to want to listen to this because it impacts them. But I think that when we think of our advocates or people who really truly can move the movement, I guess you can say, of how we see studies going towards or how we can see the differences between studies that impact men, versus women, just on a pure gender bias, is having men into the conversation because we really can't explore the impact of perimenopause and menopause and how it truly has some physiologic changes and things that we can do to enhance some of the changes that come during this time frame unless we have everyone in the conversation. And that's what I would say has truly changed science

in general when we look at say heart disease and for years for decades heart disease research was done mainly on men and we are still seeing that women still die mostly from heart disease because we weren't really focusing the studies on women and so now that we have we are starting to see how we're able to change some of the guidelines recommendations when it comes to heart disease and women because we're taking the time and that really came from bringing men into the conversation of how can we make this work for women and in total everybody because that's where we are going to see the impact is that it really helps everyone in the long run so i think feel like there is a long game to this that it impacts men because women are involved in their lives however

that might be their mothers their significant others their daughters and so this is again the importance of having men in this conversation beautiful so So why don't you give us a rundown of what's actually happening in the body during menopause? Yeah, this is like the million dollar question. Right. Because it is not like this light switch. I think that's how we've maybe phrased it or allowed people to understand how it happens. And it doesn't happen quite that way. And that's why I would I like to bring back the conversation to, women in their 40th decade because that's truly when you start to see some of those changes. Now, menopause, as I like to say, is actually, if you think about it technically, it is a very clinical term because what it means is when a woman has not had menstruation, any type of bleeding

for 12 months consecutively. So I have a lot of women who are like, oh, I'm menopausal. And I'm like, well, are you still menstruating? And they'll be like, well, I didn't have one for four months and then I had one and then I didn't have one for three months and I'm like well technically you're not menopausal and so that's why it becomes a clinical term so it's kind of like a little doctor talk we know if someone says I'm menopausal that you have gone through a 12 month time frame without menstruating now here comes the other part of the definition is that's the clinical definition so once you reach that 12 month I like to say that menopause really is like one day because it's that day that you now read 12 months without menstruating and then

And after that, you're postmenopausal. So it's almost like it's your birthday to the rest of your life, because it is that one day. But prior to that, you're perimenopausal. So even while you're going through maybe four months here without menstruation and then you bleed and then you have, that's perimenopause. But the real focus on what I want women to understand is that leading up until that day of that 12 months consecutively, you are still going to have hormonal changes. And that's where you start to see that downregulation of estrogen, the decrease in testosterone and changes in other neurotransmitters and hormones. And that happens throughout your 40th decade.

And that's why I like to educate more on the front end than just, okay, you can reach menopause and now we're here. And then, you know, we've already had all these changes that were happening during the 40th decade. And now we're trying to give you tips and tools. I think we need to bring that back a little and really get, women on the conversation topic of how does this impact your energy, your energy utilization, your weight distribution, your, you know, even your cholesterol makeup and how that changes

metabolically before we get to that menopausal stage. Yeah, beautiful. So really the conversation should be happening in the 30s in terms of understanding. I guess, you know, is, does lifestyle is kind of the time point of when you enter kind of that perimenopausal metapausal state is that a is that genetic is that pre-programmed or is something that you can modify with lifestyle I think that there are what there's two answers to that questions what we have seen in recent studies is when we actually look at ethnicities and how that actually can impact the duration of symptoms that you have, the severity of symptoms that you have and also kind of like the starting

point of when you may start to see those symptoms really do make a difference. And I think that's important as well because how we can look at ourselves as women differently, you know, through ethnicity can allow us to fluctuate how we're going to incorporate some of these lifestyle changes. And then also it is very genetically kind of connected as well, you can say. So I like to ask women who are, you know, maybe starting to have some perimenopausal symptoms or have reached menopause or close to menopause, I say, well, and this is a tough one too, because I think we're probably in our first generation of women who are very aware of what the word menopause is and having the symptoms and remembering because before it was very overlooked. So, and it was

kind of given that, oh, well, you're going through menopause, deal with it. So, you know, like my mother and probably her mother, we're not able to really give. give a good historic perspective of what their symptoms were when they started to feel some changes because it was just kind of like, yeah, this is what's supposed to happen. So just deal with it. So there was no mental recollection of hallmark changes. It was just kind of like, well, this is kind of crappy. I just got to, you know, plow through. And now we've changed that conversation. Right, right. So if you start, so I guess, you know, what are those kind of hallmark symptoms. I would imagine there's some sleep and metabolic changes. You know, there's probably a

whole suite of things that are happening. What is there an order to that? Does one happen before the other? You know, what can women start to look out for to try to keep track of what's happening in their body? So, yes, and that's a great question as well. Because before, and for good reason, you know, we have our most common symptoms of menopause. And that can usually be some of the changes such as hot flashes, night sweats, irritability, changes in sleep. And that's, and vaginal dryness is also another one. But we used to just kind of create this kind of, oh, well, you might have one of these four symptoms. What we are starting to see in studies now is that really, really has an expansive look at what that transition can look like.

And so I think the way we use our energy is differently, how our fat cells change. And so you start to see some of those fluctuations in our body habitus. You know, women usually will start to gain weight more easily. So even if they haven't really significantly changed their diet or worked out less, they still start to see some changes in how they're gaining weight. It's a little bit easier. sleep disturbances also anxiety and depression and not necessarily how we typically see anxiety and depression kind of show up in other people's lives it's this kind of rumination

inability to remember so you kind of have like this mental fog you start to have disturbances in your sleep and that can you know show up as difficulty falling asleep but also waking up throughout the night and not being able to go back to sleep. It also, libido, libido was impacted as well and how we really show up in our relationships or vaginal health changes. And our body just feels different. There's a lot of aches and pains. I have a lot of patients who are on hormone replacement therapy, which I'm sure we'll get into, who definitely see some changes in their joints hurting. And it's not an arthritis issue. It has to do with changes in hormone levels as well. as you can see, I've probably listed about 12 things that could just be on the tip of the iceberg

when we think of symptoms. But we used to just think of it as like the hot flashes, night sweats, irritability. And there's so much more to that. Yeah. And I think that's where, you know, wearable, like, for example, like, you know, we have this incredible ability to track different things, you know, so we are more aware of the subtle perturbations. You know, You know, and I think that, you know, I think a lot of folks are like, oh, that, you know, being aware of those subtle perturbations, like, is, you know, makes me anxious. And I think for me, it's, it's, it allows you to course correct before you kind of get to a point where there is no point of return, you know, where, you know, you develop insomnia or, you know,

like I think understanding, oh, wow, actually I'm spending a little bit more time awake or, oh, wow, you know, I have more disturbances than usual. you can start to take, you can start to, you know, change maybe how you're dealing with stress or managing stress throughout the day. You start to ask questions, you know, about how your daytime behaviors might be impacting your sleep or, or is there something else going on? I think it really does, I think, arm you with insight that you wouldn't otherwise have, which can be helpful. So on the topic of sleep, how would you, if someone is starting to recognize these changes, that's a little bit more difficult to fall asleep and stay asleep. They notice in their data that the quality of their

sleep is diminishing. What would be your advice for those patients? This is a great question because I feel like you're talking to me. I feel I feel heard right now, all those things you just said. Oh, my sweet girl. Like how you, like how you actually think, how is my body movement changing? How is my flexibility changing my sleep habits? These are all things that, and I'm very grateful because I'm I guess you could say at the cusp and at the helm of curiosity when it comes to perimenopausal health and how that impacts just your daily life. So I very often ask myself these questions, whereas even like I would say seven to 10 years ago, I wouldn't have probed myself this way. So I'm very glad that I, you know, this is my passion now that I'm seeing

because I do see the changes that are occurring in my life. And I'm in my mid-40s. And so this is, this is kind of like where I can say, you know, personally for myself that it's, you know, coming, showing up in my life and I want to give back to women who are younger than me, but also may be in the same time frame that they can start to ask themselves the same question so we can be much more readily available when menopause comes. Now, how I would say when it impacts your sleep, that is so important because not only is it a question of how can I improve my sleep habits, but I also want people to take a step back and look at how to sleep impact my health, because I think that's a very important conversation to have before just

saying, okay, I understand I'm having sleep disturbances, is to really see, again, the long game of how is sleep going to impact my overall health? And we know, and I'm sure you can give us really good data behind this, because that's your expertise of what we're seeing long term with decrease in sleep quality and quantity. And that can show up in heart disease. It can show up in diabetes. It can show up in metabolic disorders later on in life. And quite frankly, it really decreases the quality of life long term is what we've seen in studies. So I think it's important that we understand first that one side of it. Now, when it comes to, I know I'm having sleep disturbances, how do I improve that quality, is to, one, seek out someone who's going to

appreciate the question and give you some of the right tools and resources to improve that. And I think that can come through a variety of different ways, whether we're looking at hormones and evaluating hormones for how we may be depleted and how to restore them. And that can come in the form of hormone replacement therapy. You can also look at it from an appreciation of what are the things that are causing me to fall into these categories of sleep disturbances, whether it's I can't fall asleep because my mind is racing. And so that can come in a form of do we need to look at mindfulness meditation, breathing techniques I think are very important in order to calm the mind to then get to sleep. Is it, am I waking up because of disturbances such as hot flashes? And so that also can come from a neurotransmitter perspective on how our body is looking at

those neurons, namely the candy neuron, which was just recently revealed as one of the ways that has estrogen receptors on it. But during menopause, because we have a depletion of estrogen, is that now that interrupts the ability for that neurotransmitter to connect to estrogen, and that can, therefore be a cause of sleep disturbances. So as you can see, there's all these different mechanisms and what the sleep disturbance is, what is causing it. And that takes a really good practitioner to dig down into what is happening prior to it. And a lot of people may not be paying attention to it because they haven't been probed with the question. So once they're able to take a step back

and say, oh, I looked at this and this is probably why, or these are the symptoms that I might be having and then also of course as we're on the root podcast we know that being able to look at your sleep and getting a good depiction of what is occurring over the course of a night and where those sleep disturbances are can help us then pinpoint how do we actually address those and so also looking at nutrition i think nutrition is such an important feature of not only perimenopause and menopause, life in general. And as you can tell, nutritional sciences is really like taking off right now because finally we've realized that ultra-processed and processed foods are not really doing us any good favors. And so we're taking a step back and looking how nutrition can impact our overall

health. That's also an important feature. Yeah, that's great. I mean, there's a lot there. So you mentioned what is that moment where hormone therapy is the right path? You know, what are the, what's the criteria, I suppose that, okay, I qualify for hormone therapy. What is that conversation with a patient look like? And, and what are, you know, are there, are the, is it the symptomology that kind of pushes us there? Or is it more of like what's happening with our hormones that pushes us there? Or is it a combination of the two? it's a combination of two and you know hormone replacement therapy to me again was something you know with the w hI study in the late 90s that really kind of took us off the path of realizing the importance

of hormones and what they do for us specifically during the menopausal transition and I think we are now realizing and we did actually you know very shortly after the w hI study when they did retrospective studies on what those issues were that caused them to have to halt the study and then fine-tuning that it was actually the population that was studied that was probably not the best, that in the end, and I hope that we can probably hallmark this statement is that hormone replacement therapy is very healthy when done under the auspice of a practitioner who can stratify for risk factors and then allow for people to understand what type of hormones can be given, how it can be given, and educating well on how

to do it in a safe manner. And also the start, the start of hormone replacement therapy is also very important too, like when women actually start. And I like the way that you question that is who is really a candidate, right? And I always say everyone should be considered a candidate it until we can maybe stratify for something that would take them out of the running, I guess you could say, for hormone replacement therapy. And that's how I would prefer it to be looked at rather than there are only a few people that are candidates for it. I like to look at it as everyone can take hormone replacement therapy because it doesn't

always necessarily have to be estrogen, progesterone, and testosterone. It can be maybe just testosterone. It can be a combination of all. it can be maybe just progesterone it could be looking at your thyroid hormones as well and so i think it shouldn't be just looked at as one bucket and are you in the bucket or not but how much of that bucket can relate to me from a hormone replacement therapy standpoint that can that can be very beneficial to me and i think that takes true understanding of hormone replacement therapy and also looking at you know more of the recent literature for hormone replacement therapy to be a good

advocate for women to find which ones are good for them. Yeah, you mentioned timing. And from what I understand in the literature, that seems to be a really important piece of the puzzle in that, you know, women who are already kind of menopause, I suppose that one day where they're on the 12th month where they no longer have a period and their end menopause, hormone therapy potentially isn't as beneficial. It actually is, you know, during that perimenopause phase when hormotherapy can actually do, you know, have, have the best efficacy. Is that, is that correct? Yeah. And that is correct. And, you know, when we think of hormone replacement therapy, we really have evolved over the last few decades. And I think that we know what has become very clear is that the

risk of hormone therapy are low for healthy women less than the age of 60 and within 10 years from menopause, meaning it is more beneficial to start that hormone replacement. And I even like to scale a back to within five years of that menopausal kind of time clock that we discussed earlier to start them as early as possible. And you can even, you don't have to wait for menopause to be considered for hormone replacement therapy. I think understanding, you know, the risks and benefits. And also listening to women when they have certain symptoms is really to say, hey, would this be a great patient to start on hormone replacement therapy now rather than waiting for that, what we said, that birthday of menopause? And what are the forms? Because,

you know, there are different formulations of hormone replacement therapy. So I do believe that there are candidates, again, everyone can be a candidate. And how do we actually get them to get some type of impact and benefit from hormone replacement therapy than actually waiting for that time frame. And so what we do know now is less than 60 and within the first 10 years of menopause. And then again, I like to scale it back to even five because I want women to be so cognizant of going to ask sooner than later than waiting, you know, until we're like, oh, well, you're kind of a little bit further out from that menopausal time frame. I don't necessarily know if it's going to be as effective.

And if we're going to see some of those long-term benefits that we would like to see, then waiting too long, such as heart disease, such as metabolic syndrome, bone health is a big part of that. And then all the other outcomes that we would see that are helpful and the benefit of taking hormone replacement therapy. great so if i have a regular period so you know i am like clockwork you know and you know there's no sign that you know there's changes in my period um could i still be going through perimenopause and if the answer is yes how would i detect that is it is it is it is fluctuations across these you know estrogen and testosterone or how would i kind of know if everything else seems normal and I'm trying to get ahead of the curve, ask me for a friend.

Well, I think that for you or for any woman that, you know, is menstruating regularly, usually that's a good indication that your hormones at a level where they're like still kind of firing pretty consistently enough to elicit a menstrual cycle every month. So most times you're not going to necessarily have some of those symptoms of when you start to, I kind of like call it like the dimmer switch when you walk in a room and you're slow. only dimming that light, right? You can't perceive it's happening. And then you start to see some of those changes. So what usually happens is as you start to dial down and you start to see changes maybe in your menstrual cycle cycle, and it's not as regular is when you might start to have like

these spots on and off of symptoms. So it's not, what I'm not discounting is that you may not have those symptoms now. They may not just be as regular or severe as, someone who starts to have some of the changes in the menstrual cycles and skipping those. But that's when I also like to look at what are the things that you could implement from a lifestyle perspective and not necessarily have to take hormones. So for example, there are women who do well on birth control pills at an earlier time frame when maybe they're not menstruating, but they maybe have some changes in their symptoms. And I'd be like, you know, that could be a way that we could actually help you with some hormone replacement.

I'm putting those in quotations if you can't see me. But also, I think that there are some lifestyle changes that are going to help improve some of the symptoms that you have. So looking at your thyroid. Now, thyroid is the most common endocrine abnormality for women, especially starting at the age of 40. So you might start to see fluctuations in that. I also say exercise is a very big kind of cure, if for lack of a better term, of how you can offset some of those symptoms as well, and changing the way in which you work out too,

because that's energy utilization as well. And that's when I start to counsel some of my patients decreasing a little bit more of their cardiovascular activity, not saying that's not important, but now implementing more weight training, right, and really getting that impact there. and then nutrition as well. I think that there's such benefit to shifting some of those nutritional outcomes and how we look at food as far as medicine rather than just food intake and really using it as a source of medicine.

And then also, unfortunately, and I'm sure you've had a lot of, and I listen to Dr. Andrew Huberman on this as the alcohol, the alcohol intake should decrease as well. I know. I see that kind of. Yeah. I mean, alcohol is a poison, you know. And I mean, this is one. When you talk about data, I mean, there's nothing that moves around recovery and sleep data. Like numbers don't lie. They don't. You know, you hit on nutrition too. And it's the timing as well that I think we underappreciate. And of course, you know, my area of expertise is in circadian physiology. So I spent a lot of time, you know, studying this and inside this literature. I think that's the other opportunity for women is to really dial in on the timing of things, right? Because when we age, our melatonin production starts to decline. And that's what impacts our adiposity and, you know, our insulin resistance and all of these things that, I think, really affect the trajectory of how we age and how we feel. And so I think, you know, when you

zoom out and think about all right how do I um you know and again I think you know this is it's hard to know exactly if this is genetic or you know if this is something that's a bit modifiable but I would say that from the perspective of doing what we can do to help ourselves you know minimizing that sleep wake variability you know so really trying to stabilize when to go to bed and when we wake up is going to impact our melatonin production right and then the timing of food so I want to hear a little bit about what your prescription for just nutrition, just generally at a high level, understanding that I know this isn't your absolute expertise, but obviously as a medical doctor, you think about all of these things and you're talking to patients. So just from the

timing perspective, you know, really trying to make sure that we're giving ourselves a three-hour window of kind of ending when we eat to when we intend to sleep. We know in the literature, and in our loop data, this is very, very clear that this also moves around our sleep and recovery when we're eating close to, close to bed. So there's that timing, kind of that circadian component around timing that I think is an opportunity for folks. And then, you know, in that inside that eating window, what would you recommend women take on to really help mitigate some of those symptoms potentially or just get on the right track? So they're as well positioned as possible kind of heading into perimenopause. Now, again, I'm not an expert. But what I do,

want women to understand is the quality of food that we intake, especially when we're looking at food types, such as how we're preparing our food is a big part of that, and also what food groups we're choosing to focus on. So for obvious reasons, we live in a very diet-heavy in society that pushes diets, but what that doesn't push is longevity or sustainability by any means. Restriction is not the path. Right, exactly, right? No.

And I really try to change the construct of, I want you to be able to do something that is so long term that you don't even think of it, that 20 years from now you truly understand. You know, our brain is actually very smart, which is why it's the brain. And if we can hardwire it to some really good, I guess you can say techniques and habits, that's really where we're going to see the end result. So it's the small changes that you make, not the drastic changes of I'm dropping this from my diet or I'm dropping this from my diet is going to give us that outcome that we're looking for. And that's usually why, again, I mean, we have not seen data that shows that diet has a very good long-term result of what we're

looking for. Most people, when they're off a diet, they either gain the weight back or if we're looking at it from a lab metabolic. perspective will usually go back to what they were before because there's no true long-term change. So when I'm counseling women about nutrition, which is another beautiful thing that I have about my practice, is that we have a registered dietitian on staff because my job is to kind of get the wheel starting on. When you're in my exam room and we're talking about perimenopause and menopause, here's how I want to bring into the, the conversation nutrition. And here's who's going to continue that conversation for you and get

you on the right path is our registered dietitian. But some of the same things that you brought up as well is having that three hour. I actually do talk about that a lot is like I ask women, well, when is your last meal and when do you go to sleep? And so we may hit on some of those as well. Also intermittent fasting. What we're kind of giving ourselves, what is that time frame that we're giving ourselves on when we should be having most of our food intake and not necessarily always from a weight loss perspective but also from a hormonal perspective and what we're giving our bodies the best ability from a hormonal level but also from a metabolic perspective to do the work that it needs to do and moving away from the I have to eat all day and when we look at postmenopausal women

and we look at those changes of those hormones. We know that in the, whether you want to have a six or eight hour time frame, you're going to see changes in insulin resistance. You're going to see changes in biomarkers for oxidative stress. And so when we think of making those small steps, that is another way to have different eating strategies that's going to, in the outcome, give you some of the benefits of weight maintenance. And I'm focusing on that word weight maintenance more than weight loss is because we do see through the perimenopause and menopausal phase,

and I had said this earlier, is that we do just start to see differences in fat distribution and weight gain. And so I like to look at it from a point of, from where you are right now, how can we maintain where you are, or how can we maybe get some perks, if that's what you're looking for individually of weight loss, but that comes through those small steps. Yeah. So building muscle, prioritizing protein would be, you know, two really big steps and getting sleep. So you have the exercise capacity and that in your hormones, your signaling hormones are regulated.

Yeah, you intermittent fasting, I think, is always a really interesting topic. And I always like want to want to point out that, you know, time restricted eating and intermittent fasting are actually two different things. there's a circadian component to time-restricted eating, and there isn't a circadian component to intermittent fasting. And I think if people are looking to optimize their hormones and I think, you know, mitigate a lot of the symptoms, I think a time-restricted eating where you're biasing a bulk of your calories in the front end of the day when the light is out, you know, as opposed to the back end of the day, I think that can really help, you know, sleep, for example.

And again, this is a gal who's in a lot of data, right? So I'm not just talking off the cuff. I can tell you that, you know, we want to bias our calories earlier in the day. So I think intermittent fasting, I think, can be an incredible strategy. but I almost think, and I would love to hear your opinion on this, I think for women who are trying to really stabilize their hormones and stabilize sleep, thinking about a more of a time-restricted eating window and prioritizing a bulk of the calories when the sun is up and then giving that three-hour buffer prior to when they sleep, to me, follows the circadian rhythm and I think sets us up, I think, for, you know, optimal. minimizing, you know, our insulin levels and, and, you know, I think preventing a lot of the metabolic issues that come with, with just eating over 17-hour window, for example, which is what a majority of Americans do, right? And I wanted to ask you that. This is for, this is for selfish reasons. How did we get so far off of the, I'm, it's just modernity, you know, it's just light.

We have access to light. I think, too, like, and this is, you know, I, you know, I'm a concept thinking about, you know, how we get off track and how do we get it back on track and definitely obviously having constant access to light, but constant access to food. You know, we're not having to go out and hunt our elk and then cook it by the fire. It's like always in our face. We have a fridge right there that is accessible 24-7. Like we are never without driving down the street. I know. I know. We can, I know. So I really think we need to just, if we just reeled in our timing of when we eat and restrict the timing, I think we probably solve a majority of our metabolic issues, honestly. Without a doubt, there's quality

issues, right? In terms of you mentioned it in the beginning, the processed food, we need to find a way to help Americans minimize the amount of processed food. And this is a big project, of course. But I think if we could just start by kind of narrowing our window of time that we're eating, we will help ourselves massively. And eating, you know, when it's light out during the active phase of our circadian rhythm like this gets us this will get us so far and i think will help women and men you know any any any individual any person who is trying to gain more control more balance be able to be alert when they want to be alert and sleepy when they want to be sleepy and have exercise capacity you know to to move their body in a way that they want with their body i mean i think to me

the root of all this is is a large part around around timing you know i really um appreciate what what you just said because what I deal with in my practice and I deal with mostly menopausal and sexual health is this change or this time frame in a woman's life is so detrimental to how it plays out in your 60s, 70s, and 80s. And that's why I really focus on the 40s and 50s because we really have the ability to change the trajectory at this point. I think that has a lot to do with mindset. One of the things that I'm like an advocate for and I preach it to all my patients and that's what we offer here at my practice, you know, is trauma recovery. We do sex and intimacy coaching because there's such a big shift in mindset of how we may need to take on new, new habits,

habits, how we think of ourselves, how we show up in life, and how we're treated, quite frankly, from society. Like, you mean, you hear this all the time is that after a certain time frame, women just kind of are not given the respect or the time or the luxury of having power. And I think mindset and being able to give yourself back that power and empowering ourselves is such a big part of taking on these new and I don't want to call it challenges because it physiologically everything that happens during perimenopause and menopause is going to happen but how do we change the ability for women to understand this in a way where

it's not negative we've put such a negative connotation on menopause and I'm really like my passion over these next few years and maybe for the rest of my life is to change like how do we change that that conversation and how do we identify some of the things that are taking away the ability for women to say this should not change my value or my attitude or my behavior and wanting to take it active be an active participant in this transition yeah you know I feel like mindset obviously can be an incredibly powerful um a fact sector, you know, in so many ways. And I think like what you, you know, just what you've outlined in this conversation is there's, there's kind of a foundation of behaviors, you know, that are going to

help us if we're in our 20s, in our 30s, it doesn't matter, right? There's these foundational set of behaviors. And you mentioned sleep. You mentioned exercise. You mentioned, you know, nutrition. And we got to get these right, you know, and they're going to change a little bit in terms of our needs across our lifetime and we need to kind of keep track of how we're doing across these different pillars. But if we don't have this foundation right, you know, it's hard to talk ourselves into a better future, right, from a mindset perspective. So it's kind of like you've got this approach where, all right, let's get the foundation right. Let's establish like a lot of efficacy or, you know, a lot of self-efficacy in these areas. And then I

feel empowered and more control over my health. So then tweaking that mindset becomes a little bit more achievable, right? Like we can talk ourselves around some of these, you know, inconveniences, I think, right? Because it's the small changes, just like you said. If there are, you know, if we're going through this journey and we're empowered, we have really good foundation, those things that may come up here and there, we have the ability to make those small changes because it's not this like huge undertaking or this, I now have to change everything in my life. But if I can give someone the tools early on and they have taken a good portion of those tools from early on, those changes that come later, you know, every five years, 10 years, so much easier for us to handle than being

like, I have to change the whole system and rerun the whole engine. And I mean, that's hard. And no one wants to do that. And that's kind of what we are seeing now today is we wait for menopause to happen. Then we're like, oh, by the way, because this stuff has been happening over the last 10 years, I'm going to need you to do a complete overhaul in how you think, what changes you need to make. And then we'll be good. Most people are going to be like, I'm not doing that. Yeah. Right. So that's why we've got to get this conversation started so much earlier. I love it. I love it. I mean, you're doing so much to raise awareness. I mean, I already feel like just in the last two years, you know, I think just women's health is just emerged as like

a topic. I mean, it's just amazing. And you're a big reason for that. Other leaders like yourself in this space who are really speaking out and normalizing a lot of these conversations. So just pause and thank you so much for all the work that you're doing in this area. I think, you know, one of the things that, one of the questions that we get from our members is about just the health risks. So, you know, I guess is there a case to be made for being proactive in these kind of years leading into perimenopause and menopause, you know, how do we mitigate the risks of osteoporosis and weight gain and urinary track infections, heart disease, things that happen in that postmenopausal period. Obviously, you've already mentioned a lot of things that we

need to do to that foundation, I guess we go back to. So, is there anything else that we need to do to kind of minimize risk? And then let's say we've got folks who are in post menopause. So they've already hit metapause or in post menopause. And the risks are of of these things start to increase. You know, what can we do pre, if anything, we have missed? And what can we do post? I would say if I were to like write a recipe for decreasing risk. And before even go into that, I want to like highlight the risk. of what we see with menopause, mainly due to literally a decrease and depletion, if you want to call it that of estrogen.

So what we know is that with a decrease in estrogen, you're going to see an increase in heart disease. And that has to do, again, with the actual muscle of the heart, and that has a decrease kind of work ethic, I guess you could say, of the heart muscle. You start to see more heart failure, right? It's like, yeah, I'm kind of higher now. Right. And then also how are cholesterol, so our LDL levels will increase.

And we know the higher your LDL levels are that's going to contribute more to what we call atherosclerotic change, which causes plaque, which causes heart disease, etc. We do start to see changes in type 2 diabetes. And that's because we see changes in our insulin and glucose ratios, how insulin is utilized, and sensitivity as well. And then we also see changes in metabolic syndrome. And that has to do with, again, our visceral fat, our lean body mass, our lipid profiles. And those all create what we call the changes in our body constitution, how we distribute fat, and then brain health. Very big thing that we're starting to see in how decrease in estrogen is going to increase a risk of Alzheimer's

disease, dementia, et cetera, and our cognitive function. So that's another reason why we have to pay attention to that as well. And also colon cancer. And then bone health. Bone health again. So when do you typically start to see, you know, your hip fractures, your wrist fractures, et cetera, is after menopause because we have a decrease in estrogen. And estrogen induces what we call like the buildup of our bone. So if you have a decrease in estrogen, your bones are not being built up to the, you know, what they used to in the past when you had estrogen exposure. And so you start to see more osteoporosis, more bone loss, and that's when you start to see more of your fractures. And so if you were to look at it from that perspective alone, you're like,

what can I do to help ensure that I'm giving myself the best bet and the best quality of life? Because we're all going to age. But we also have the ability to choose how we like to age. and that comes in the forms of how can I improve my quality of life. And that comes with, I'm going to give you the recipe now, everyone ready. I love it. A long, like kind of prelude there. The recipe is looking at hormone replacement therapy differently. Just giving yourself the ability to have the conversation with someone who's very well versed

in it and how they can provide you. What is my risk if I were to start hormone replacement therapy? Do I have risk factors? And how can I use it to my benefit? Next, I would say nutrition. Nutrition is ever so important. How we conceptualize food as medicine. Third, I would say exercise. One, you need to exercise. That's the recipe. And if you do exercise already, changing how we exercise. So, for example, increasing your weight-bearing activity and weight training to help implement your bone health and longevity and sustainability. And then last, I would say sleep. Now, I, even me, I don't think I realized how important sleep was, and whoop is obviously helping me see how poorly I'm doing in that department. I'm not going to say that I have everything together, but sleep.

So that, and the last one I would say, so I have a recipe of five, is really mindfulness in the form of meditation, yoga, breathing techniques. that's something that I feel has impacted our lives and my life specifically so much but can help so many women. Yeah. So getting cortisol in check. That's the recipe. That's it. And that's going to help sleep. You know, that's amazing. Yeah. And I think women to take on stress differently. Men are stressed too where everyone is stressed. But I think proactively mitigating stress throughout the day obviously is really important, right? That's going to impact. Yeah, because stress is going to be there. stay asleep. It's going to be there. It's just a matter of dealing with it, you know, in an

appropriate way and being able to measure the amount of stress that's being put on our on our bodies physically, but cognitively and emotionally. And then just taking steps to, you know, to kind of, I guess, map that stress with appropriate amounts of rest, essentially. I think breathing, breathing can be an incredible form of that. The one thing, you know, one I would maybe add to the recipe. And I, and I thought about it. Yeah, I want to hear, oh, let's put some additions in that recipe. Well, I just think, you know, I think sleep, you know, strength, stress, and social, if I put all S's, you know, my teacher side of me is coming in.

Yeah. But social connection, you know, Peter Tia, and I have not read this, so please forgive me, I'm going to butcher the heck out of this, but it was a mouse study. But they basically saw a connection between plaque buildup in, I think it was bunny. So the bunnies that had more social connection. So we're petted and, you know, we're around humans in like a kind of a social connection type of way, had less plaque than the control group who didn't have access to who weren't petted, who were just basically in a cage and left on their own. So that's kind of interesting. I don't know. I need to read the study, but we know social connection is really important. And I think it's important for women of all ages, right? But I think it's especially as we're transitioning into this next phase of life, you know, making sure that our social connections are really strong

and that we feel like we have community. I feel it is probably a really big piece of the puzzle too. I actually, I don't know. There was a recent interview. Jane Fonda was giving an interview. Did you see that? And she was talking about, you know, in her age how social connection is so important,

being intentional with her friendships. And I was like, that was just like, a beautiful way for her to have expressed it, but it really runs along with what you just said about the social connection. Yeah. Yeah. And I think it's, and it's not just, I think you said, intention and, you know, I think quality social connections. I think we can have, we can be a part of the wrong communities, you know, and wrong for us, you know, and I think really evaluating, you know, what, what actually are my needs, you know, as a human being and what type of connections do I need in order to feel, be the best version of myself, you know, and kind of having a more intentional

conversation with oneself around that, I think is really key for every stage of life. But I think it's certainly when there's lots of changes happening in our body that can really be disruptive. And I think having that stability around us is really important. Oh, this would be, this will be a good one. You kind of talked about this a little bit, but Don Lemon from CNN recently stated that a women is only considered to be in their prime in 20s, 30s, and maybe 40s. Go. So I, when I heard it, I was like, surely he did not mean it that way. And then like, there's, there's two sides to this. I think one, I think he didn't realize the words that

were coming out of his mouth. Yeah, I think it can happen. I think when he looked back at it, he was like, what was I saying? And, you know, for me, who does a lot of, lot of media. Sometimes there are times you're just talking. And you're like, what the hell am I saying? Did I just say? Happens to me way too often. Yes. And so I was trying to give him grace there. But then I also think that there is this strong societal belief of women. And that comes from sexism and patriarchy that people, it's kind of rooted in them because that's what society has bred. right and so i do believe that there is some truth to maybe how he yeah perceive that but then again on the other side like he is very forward thinking and totally and so i think that it was this

combination of oh maybe that is something that i i didn't realize it was was deep rooted in me yeah but i don't necessarily believe it but i don't think it had ever become a topic of conversation in his head until it was said yeah right and so i do try to give him grace but if like he were in front of me I'd have been like so what did you mean you know I'm always big about accountability because if he were and I think granted I don't know him and sit down and talk to him I believe if I were having a conversation with him I do believe he could introspectively look at that comment and see how it was wrong and I and maybe taking the steps to understand why he thinks that or why it came up that or came out of his mouth that way and I think that there are a lot of

people who do have a lot of bias, whether it's like sexism, racism, whatever it is, but don't know that it's there until it comes up in conversation or they're charged with a question and that's how they reveal their answer. My true value of a person is we all have those moments of, I didn't know that I thought that. But when it does come up, what are you doing to evaluate, self-reflect, understand what needs to be changed and make those changes. And if someone doesn't have the ability to do that, that's what I can't jive with. But if someone has the ability to say, you know what, that was kind of messed up what I said. And I'm going to take accountability for it. And not only am I going to take accountability for

it, I'm actually going to do the steps that's needed to understand where it came from and what I can do to change it. Outside of that, I'm like, well, that's just BS, you know. But we have to, we have to be responsible. We have to be socially responsible. and also self-responsible that's beautifully said yeah i think you know when as we i think as as as we become more educated about the things that we can do to i think improve our health over the lifespan and you know i think there's a lot of incredible examples of women getting stronger and building muscle and, you know, starting to think more proactively about nutrition and really trying to, you know, make sure that, you know, are limiting alcohol, you know, knowing that that

is going to really impact sleep and exasperate, you know, these symptoms potentially, you know, I think. So there's a lot of like, like, really good examples of women who are speaking out about that and are, you know, and are kind of walking the walk, you know, how do you see, you know, if you're to think about kind of this whole women's health space, you know, particularly as it relates to kind of this perimenopause, menopause group, like what's your vision for, you know, the space, I think, in 10 years? Like, where would you love to see it in 10 years? Oh, I like that question. Where do I see women's health or menopausal health or how we work ourselves into this next chapter of our lives? Where do I see that in the next 10 years? I see because of things such as

wearable devices such as whoop. I see it being because we have more visibility to menopausal healthy. New York Times just recently came out with an article, women have been misled in menopause. And continuing efforts from experts such as myself and others in our community, I think we are going to see a phenomenal change. I think it's high time that we do. But I also see the community coming together to want more questions to probe for more answers. and that's really where we're going to see the change is when we start to see the change in the women understanding that they don't necessarily have to go through this transition that way and that they want answers. And that's where we're going to see practitioners understanding how to not treat

the disease, but treat the person. And fundamentally, we are going to do ourselves so much better when we're able to understand health and wellness in a perspective of the individual rather than the disease. I love that. It's a beautiful answer. And I know from for my perspective, and, you know, just I have a daughter and, you know, I think about her future a ton, obviously. And, you know, it's efforts from folks like yourself, you know, who are really, I think,

changing the game for all of us and what that future actually looks like. So I cannot thank you enough for how dedicated you are to this space and how brave you've been just like pushing on this conversation and forcing these conversations, frankly. It's really, it's, you're super inspiring and just feel really grateful to to be able to work with you on our science advisory council and be able to bring, you know, your intelligence and insight into our platform for our members. I just can't thank you enough. So appreciate you today. Thank you. Oh, thank you so much for having me. And I really look forward to what we're going to see with data from loop in helping women during this transition. Thank you. Dr. Shepard, where can

folks find you to just follow all the incredible work that you're doing? Yeah, I really put as much information that I can on my Instagram as probably the best. It's Jessica Shepard M-D, J-E-S-S-I-C-A, S-H-E-P-H-H-H-E-H-H-E-R-D-M-D. and I really give as much context as I can on any aspect of menopause on there and would love to hear people's questions so I can answer it that way. But join me there and follow me there and also for my practice. Sanctam Med and Wellness here in Dallas. On Instagram, we are Sanctum-T-U-M-E-D Wellness, W-E-L-L-L-N-E-S-S. Amazing.

And when you are on the Today Show or Good Morning America or Dr. Dr. Oz, is that do you post that on Instagram so people can tune in live if they want to? Yeah, I do. And I love to hear the feedback. And again, what people want to understand more about this so I can make it applicable to them. Yeah. And would you say no question is out of bounds? No, no questions. Related to health. And also, if I don't know the answer, I will send you to the person who does. Amazing. Amazing. Well, thank you again. And I know we'll be chatting soon. Thank you.

Thanks again to Dr. Jessica Shepard for joining us this week to discuss menopause, paramenopause, and the women's health space. If you enjoyed this episode of the WOOP podcast, please leave us a rating or review. Check us out on social at Woop at Will Ahmed. If you have a question, email us podcast at Woop.com. Call us 508-433-4952. New members can use the code Will. Get a $60 credit on Woop Accessories.

That's Woop. You can join now for our lowest rates ever. And that's a wrap. Thank you, everyone, for listening. And we'll catch you next week on the WOOP podcast. Stay healthy and stay in the green.